Bipolar disorder roadmap: Navigating warning signs from childhood to adolescence in offspring of patients

Behavioural problems during childhood, along with delayed circadian rhythm, social anxiety, and mood symptoms in adolescence, may serve as early indicators of bipolar disorder in offspring of Chinese parents with the disorder, a case-control high-risk offspring study has shown.

“Given the heritability of bipolar disorder, which can be as high as 83 percent, studying high-risk offspring is a well-established method for identifying prodromal markers or risk factors of bipolar disorder,” wrote the researchers. “However, previous studies on the emergence of psychopathologies and circadian dysfunction among high-risk populations were limited and showed inconsistent results.” [Gen Psychiatr 2024;37:e101239]

In the current study, the researchers partnered with 10 hospitals in Hong Kong and Guangdong to recruit 191 offspring of parents with bipolar disorder (mean age, 11.88 years; female, 46.07 percent) and 202 control participants whose parents do not have the condition (mean age, 11.54 years; female, 49.25 percent). Sleep/circadian rhythm dysfunction and mental disorders were assessed by the Diagnostic Interview for Sleep Patterns and Disorders, and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, respectively.

Overall, children of bipolar disorder patients showed nearly five-fold higher risks of mood disorders (11.70 vs 3.47 percent; adjusted odds ratio [OR], 4.68; 95 percent confidence interval [CI], 1.30–16.86) and social anxiety (6.28 vs 1.49 percent; adjusted OR, 4.70; 95 percent CI, 1.21–18.18), and four-fold higher risks of depressive disorders (11.17 vs 3.47 percent; adjusted OR, 3.99; 95 percent CI, 1.11–14.34) and delayed sleep phase symptoms (5.62 vs 1.03 percent; OR, 5.71; 95 percent CI, 1.21–27.04) vs controls.

The researchers further divided the offspring into two age subgroups: <12 years (childhood) and 12–21 years of age (adolescence). Notably, children of bipolar disorder patients showed a two-fold higher risk of behavioural symptoms (48.54 vs 30.69 percent; adjusted OR, 2.13; 95 percent CI, 1.14–3.95) during their childhood. During adolescence, children of bipolar disorder patients also exhibited a 7.5-fold higher risk of social anxiety (11.36 vs 2.00 percent; adjusted OR, 7.49; 95 percent CI, 1.33–42.20), a four-fold higher risk of delayed sleep phase symptoms (adjusted OR, 4.04; 95 percent CI,1.23–13.28), and a three-fold higher risk of mood symptoms (adjusted OR, 3.00; 95 percent CI, 1.14–7.92) vs controls.

Three-quarters of mental illness cases emerge before the age of 24. [Arch Gen Psychiatry 2005;62:593-602] “Our findings revealed the roadmap of psychopathological changes in high-risk individuals before their conditions develop into full-blown clinical bipolar disorder, allowing the use of early intervention or prevention strategies,” remarked the author of the study, Dr Bin-Bin Lei of the Department of Psychiatry, Chinese University of Hong Kong (CUHK).

“Potential strategies include maintaining regular sleep-wake routines, avoiding electronic devices before bedtime, and cognitive and behavioural intervention for anxiety and mood disorders, especially during the critical period of [childhood and] adolescence,” added Professor Yun-Kwok Wing of the Department of Psychiatry, CUHK.